超声造影在头颈部淋巴结良恶性病变鉴别诊断中的应用

目的分析头颈部淋巴结病变超声造影(CEUS)特点。方法对38例(89枚)头颈部淋巴结肿大患者进行CEUS检查,观察淋巴结的强化分布类型并对其时间-强度曲线进行分析。结果 89枚淋巴结中,穿刺或手术后病理证实33枚(37.1%)为良性淋巴结,56枚(62.9%)为转移性淋巴结。良性淋巴结表现以均匀强化为主(26/33,78.8%,P=0.000),转移性淋巴结以不均匀强化为主(32/56,57.1%,P=0.000)。良性淋巴结时间-强度曲线形态以快退为主(19/33,57.6%,P=0.000),转移性淋巴结以慢退为主(50/56,89.3%,P=0.000)。CEUS鉴别诊断良恶(转移)性淋巴结的敏感度、特异度分别为92.9%、72.7%,常规超声为82.1%、69.7%,两者之间比较差异无统计学意义(P=0.649,P=0.239);两种手段结合应用敏感度、特异度分别为98.2%、84.8%,与常规超声比较,仅敏感度差异具有统计学意义(P=0.011)。结论 CEUS可以对颈部淋巴结进行良恶性鉴别,能够在强化分布、灌注模式(进退方式)方面提供有用的信息,与常规超声结合使用,则可明显提高其诊断的敏感度。

Contrast-enhanced ultrasonography in differentiation of malignant from benign enlarged lymph nodes of the head and neck

Objective To evaluate the ultrasound characteristics of enlarged cervical lymph nodes by contrast-enhanced ultrasonography （CEUS） and its time-intensity curve （TIC）. Methods Thirty-eight patients with 89 enlarged lymph nodes were examined by CEUS. The enhancement patterns and TIC of benign and malignant nodes were assessed. Results The 89 nodes included 33 （37.1%） benign and 56 （62.9%） malignant lymph nodes confirmed by pathological examination. Twenty-six （78.8%, P=0.000） of the 33 benign lesions had homogeneous enhancement. However, 32 （57.1%, P=0.000） of the 56 malignant nodes showed inhomogeneous enhancement by CEUS scanning. Nineteen （57.6%, P=0.000） of the 33 benign nodes were displayed as a fast-down pattern of the contrast agent perfusion, but 50 （89.3%, P=0.000） of the 56 malignant nodes were described as a slow-down pattern in TIC analysis. The sensitivity and specificity were 92.9% and 72.7% obtained by CEUS, and 82.1% and 69.7% by conventional ultrasound （B-mode and color/power Doppler imaging） in the differentiation of benign and malignant lesions （P=0.649 and P=0.239）. The combination of conventional ultrasound and CEUS showed high sensitivity （98.2%） and specificity （84.8%） with a significant difference （P=0.011）. Conclusion CEUS is valuable for differentiation of malignant from benign lymph node by visualization of different enhancement and perfusion patterns with a significantly higher sensitivity in combination with conventional ultrasound.